Left Inguinal Hernia, Sigmoid Diverticulum and a Probable B4 Type Duplicated Appendix

Objective: We present a case report of an 89 years old male with a diagnosis of incarcerated left inguinal hernia, with surgical findings of a complicated sigmoid diverticulum and a tubular structure of 0.5 mm attached to the sigmoid colon, fixed to the inguinal ligament with a true lumen that could correspond to a duplicated appendix B4 type. Introduction: Colon diverticular disease is more frequent in western countries, present in 30% of 60 years old patients and in more than 50% in 80 years old patients, with 95% of the times located at sigmoid colon. The most frequent complication is the acute diverticulitis (25%) and in 30% of these patients, surgery is required. Discussion: Acute, complicated, diverticular disease is an infrequent pathology, even more, a colonic diverticulum included within the hernia sac. Of the appendix congenital malformations, a duplicated appendix is the rarest; usually found in asymptomatic adults as an incidental find during abdominal surgery or during contrasted abdominal scans. Conclusion: Awareness must be raised within first-contact health care professionals about diagnosing surgical entities with high mortality rates, in asymptomatic patients with unclear clinical findings, especially with the occurring of a demographic transition in most countries. In this specific patient, Hartman surgical procedure and a second time inguinal plasty were the best surgical options for this patient; even considering the mortality rates (25%) of a perforated diverticulum, considering added surgical site infection.